OTSC吻合夹与外科治疗在难治性消化性溃疡并出血中的疗效比较*

Comparison of clinical efficacy of over-the-scope clip system and surgical operation for treatment of refractory peptic ulcer bleeding*

摘要:

摘要：目的 比较内镜OTSC吻合夹止血与外科手术治疗难治性消化性溃疡并出血的临床效果。方法 共44例经常规药物和内镜下止血无效的难治性消化性溃疡并出血患者纳入研究，其中20例患者接受内镜下OTSC吻合夹止血治疗（研究组），24例患者接受外科手术治疗（对照组），术后随诊6个月，对比两组患者手术时间、住院时间、住院费用、手术并发症发生率、出血止血率和术后再出血率。结果 研究组的手术时间（23.38±4.31）min较对照组（135.01±35.17）min明显缩短，差异有统计学意义（P <0.05），住院时间（18.21±7.22）d较对照组（27.25±12.77）d明显缩短，差异有统计学意义（P <0.05）。研究组住院费用（72 480.73±42 663.75）元明显低于对照组（97 498.45±58 998.78）元，差异有统计学意义（P <0.05）。研究组急性期止血率为95.00%（19/20），对照组为100.00%，两组患者急性期止血率比较，差异无统计学意义（P >0.05）。研究组和对照组术6个月内再发出血各1例，两组患者再发出血发生率比较，差异无统计学意义（5.00% vs 4.17%，P >0.05）。研究组术后吻合夹残留4例，对照组术后粘连性肠梗阻1例，术后感染2例，两组并发症发生率比较，差异无统计学意义（20.00% vs 12.50%，P >0.05）。结论 内镜下OTSC吻合夹与外科治疗均是难治性消化性溃疡并出血的安全、有效的方法，内镜下OTSC吻合夹止血术具有技术简单易行、恢复快和费用低等优势。

Abstract:

Abstract: Objective To compare the clinical efficacy of over-the-scope clip (OTSC) and surgical operation in treatment of refractory peptic ulcer bleeding. Methods 44 cases refractory peptic ulcer bleeding patients who exhibited poor response to conventional and endoscopic therapy were included in the study. Patients of study group were treated with OTSC, and patients of control group were given surgical operation. All the patients were followed up 6 months after treatment. Surgical time, hospitalization time, hospitalization expense, incidence of complications, haemostatic rates, rebleeding rate were compared between the two groups. Results Surgical time of study group (23.38 ± 4.31) min was significantly shorter than that of control group (135.01 ± 35.17) min, P < 0.05. Hospitalization time of study group (18.21 ± 7.22) d was shorter than that of control group (27.25 ± 12.77) d, P < 0.05. Hospitalization expense of study group was significantly lower than that of control group [(72 480.73 ± 42 663.75) vs (97 498.45 ± 58 998.78) RMB, P < 0.05]. 4 patients were found OTSC residue in study group, while the incidence of surgical complication in control group was 12.50%, including one case of adhesive intestinal obstruction and two cases of postoperative infection, the incidence of complications showed no significant difference between the two groups (P > 0.05). There was no significant difference in the control of acute bleeding between the two groups (95% vs 100%, P > 0.05). One case of rebleeding occurred in both groups in 6 months after treatment, rebleeding rate showed no difference between the two groups (5.00% vs 4.17%, P > 0.05). Conclusion OTSC and surgical operation are safe and effective for the treatment of refractory peptic ulcer bleeding, while OTSC is a simple technique with the advantages of simple, quick recovery and low cost.